DOI QR코드

DOI QR Code

Evaluation of enteral formulas for nutrition, health, and quality of life among stroke patients

  • Kang, Yun-Kyeong (College of Pharmacy, Sookmyung Women's University) ;
  • Lee, Ho-Sun (College of Pharmacy, Sookmyung Women's University) ;
  • Paik, Nam-Jong (Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Kim, Woo-Sub (Department of Rehabilitation Medicine, Seoul Veterans Hospital) ;
  • Yang, Mi-Hi (College of Pharmacy, Sookmyung Women's University)
  • Received : 2010.03.03
  • Accepted : 2010.09.16
  • Published : 2010.10.31

Abstract

Enteral nutritional support has been used via tube feeding for dysphagic stroke patients. We performed long and short term trials to evaluate the effects of commercial enteral nutritional supports on nutrition and health in stroke patients (mRS = 3~5) and quality of life in their caregivers. For a long term study, we recruited chronic (${\geq}$ 1 yrs) stroke patients (n = 6) and administered them 6 cans/day (1,200 kcal) of the commercial enteral formula N for 6 months according to IRB-approved protocol. We collected peripheral blood at 0, 2, 4 and 6 months. For a short term study, we recruited acute (${\leq}$ 3 months) stroke patients (n = 12) and randomly administered them two different commercial enteral formulas, N or J, for 2 weeks. We collected their blood at 0, 4, 7 and 14 day of the administration. Blood samples were analyzed to quantify 19 health and nutritional biomarkers and an oxidative stress biomarker, malondialdehyde (MDA). In order to evaluate quality of life, we also obtained the sense of competence questionnaire (SCQ) from all caregivers at 'before' and 'after trials'. As results, the enteral formula, N, improved hemoglobin and hematocrit levels in the long term trial and maintained most of biomarkers within normal ranges. The SCQ levels of caregivers were improved in the long term treatment (P < 0.05). In a case of the short term study, both of enteral formulas were helpful to maintain nutritional status of the patients. In addition, MDA levels were decreased in the acute patients following formula consumption (0.05 < P < 0.1). Most of health and nutrition outcomes were not different, even though there is a big difference in price of the two products. Thus, we evaluate the formula N has equal nutritional efficacy compared to the formula J. In addition, long term use of enteral formula N can be useful to health and nutrition of stroke patients, and the quality of life for their caregivers.

Keywords

Stroke;enteral nutrition;sense of competence questionnaire;biomarkers;malondialdehyde

References

  1. Foley NC, Martin RE, Salter KL, Teasell RW. A review of the relationship between dysphagia and malnutrition following stroke. J Rehabil Med 2009;41:707-13. https://doi.org/10.2340/16501977-0415
  2. Elmstahl S, Bulow M, Ekberg O, Petersson M, Tegner H. Treatment of dysphagia improves nutritional conditions in stroke patients. Dysphagia 1999;14:61-6. https://doi.org/10.1007/PL00009588
  3. Kim HJ, Kang EH, Lee JH, Kim OY. A study of nutritional improvement in the patients with neurologic disorders by changing enteral feeding methods. Journal of the Korean Dietetic Association 2004;10:442-51.
  4. Unosson M, Ek AC, Bjurulf P, von Schenck H, Larsson J. Feeding dependence and nutritional status after acute stroke. Stroke 1994;25:366-71. https://doi.org/10.1161/01.STR.25.2.366
  5. FOOD Trial Collaboration. Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke 2003;34:1450-6. https://doi.org/10.1161/01.STR.0000074037.49197.8C
  6. Martineau J, Bauer JD, Isenring E, Cohen S. Malnutrition determined by the patient-generated subjective global assessment is associated with poor outcomes in acute stroke patients. Clin Nutr 2005;24:1073-7. https://doi.org/10.1016/j.clnu.2005.08.010
  7. Lipman TO. Grains or veins: is enteral nutrition really better than parenteral nutrition? A look at the evidence. JPEN J Parenter Enteral Nutr 1998;22:167-82. https://doi.org/10.1177/0148607198022003167
  8. Gadek JE, DeMichele SJ, Karlstad MD, Pacht ER, Donahoe M, Albertson TE, Van Hoozen C, Wennberg AK, Nelson JL, Noursalehi M. Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med 1999;27:1409-20. https://doi.org/10.1097/00003246-199908000-00001
  9. Poulshock SW, Deimling GT. Families caring for elders in residence: issues in the measurement of burden. J Gerontol 1984;39:230-9. https://doi.org/10.1093/geronj/39.2.230
  10. Vogt TM, Mullooly JP, Ernst D, Pope CR, Hollis JF. Social networks as predictors of ishemic heart disease, cancer, stroke and hypertension: incidence, survival and mortality. J Clin Epidemiol 1992;45:659-66. https://doi.org/10.1016/0895-4356(92)90138-D
  11. Glass TA, Matchar DB, Belyea M, Feussner JR. Impact of social support on outcome in first stroke. Stroke 1993;24:64-70. https://doi.org/10.1161/01.STR.24.1.64
  12. Scholte op Reimer WJ, de Haan RJ, Rijnders PT, Limburg M, van den Bos GA. The burden of caregiving in partners of long-term stroke survivors. Stroke 1998;29:1605-11. https://doi.org/10.1161/01.STR.29.8.1605
  13. Gornall AG, Bardawill CJ, David MM. Determination of serum proteins by means of the biuret reaction. J Biol Chem 1949;177: 751-66.
  14. Herbert V. Introduction to the "nutritional anemias". Semin Hematol 1970;7:2-5.
  15. Doumas BT, Watson WA, Biggs HG. Albumin standards and the measurement of serum albumin with bromcresol green. Clin Chim Acta 1971;31:87-96. https://doi.org/10.1016/0009-8981(71)90365-2
  16. Bucolo G, David H. Quantitative determination of serum triglycerides by the use of enzymes. Clin Chem 1973;19:476-82.
  17. Richmond W. Preparation and properties of a cholesterol oxidase from Nocardia sp. and its application to the enzymatic assay of total cholesterol in serum. Clin Chem 1973;19:1350-6.
  18. Buffone GJ, Lewis SA, Iosefsohn M, Hicks JM. Chemical and immunochemical measurement of total iron-binding capacity compared. Clin Chem 1978;24:1788-91.
  19. Ueland PM, Refsum H, Stabler SP, Malinow MR, Andersson A, Allen RH. Total homocysteine in plasma or serum: methods and clinical applications. Clin Chem 1993;39:1764-79.
  20. Bachorik PS, Ross JW. National Cholesterol Education Program recommendations for measurement of low-density lipoprotein cholesterol: executive summary. The National Cholesterol Education Program Working Group on Lipoprotein Measurement. Clin Chem 1995;41:1414-20.
  21. Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957;2:200-15.
  22. Wilson JT, Hareendran A, Grant M, Baird T, Schulz UG, Muir KW, Bone I. Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale. Stroke 2002;33:2243-6. https://doi.org/10.1161/01.STR.0000027437.22450.BD
  23. Templar J, Kon SP, Milligan TP, Newman DJ, Raftery MJ. Increased plasma malondialdehyde levels in glomerular disease as determined by a fully validated HPLC method. Nephrol Dial Transplant 1999;14:946-51. https://doi.org/10.1093/ndt/14.4.946
  24. Yagi M, Tani T, Hashimoto T, Shimizu K, Nagakawa T, Miwa K, Miyazaki I. Four cases of selenium deficiency in postoperative long-term enteral nutrition. Nutrition 1996;12:40-3. https://doi.org/10.1016/0899-9007(95)00062-3
  25. Nagano T, Toyoda T, Tanabe H, Nagato T, Tsuchida T, Kitamura A, Kasai G. Clinical features of hematological disorders caused by copper deficiency during long-term enteral nutrition. Intern Med 2005;44:554-9. https://doi.org/10.2169/internalmedicine.44.554
  26. Gossner L, Keymling J, Jazji S, Konig HJ, Hahn EG, Ell C. Therapeutic results of long-term enteral nutrition by percutaneous endoscopic gastrostomy (PEG)-A retrospective analysis of 1211 patients. Gastrointest Endosc 1995;41:364.
  27. Ledermann SE, Shaw V, Trompeter RS. Long-term enteral nutrition in infants and young children with chronic renal failure. Pediatr Nephrol 1999;13:870-5. https://doi.org/10.1007/s004670050718
  28. Truby H, Cowlishaw P, O'Neil C, Wainwright C. The long term efficacy of gastrostomy feeding in children with cystic fibrosis on anthropometric markers of nutritonal status and pulmonary function. Open Respir Med J 2009;3:112-5. https://doi.org/10.2174/1874306400903010112
  29. Yamamoto T, Nakahigashi M, Umegae S, Matsumoto K. Enteral nutrition for the maintenance of remission in Crohn's disease: a systematic review. Eur J Gastroenterol Hepatol 2010;22:1-8. https://doi.org/10.1097/MEG.0b013e32832c788c
  30. Yoon SJ, Hawe WD. A study on calorie and proximate components of traditional Korea gruel. Journal of the Korean Society of Food Science and Nutrition 2008;37:879-85. https://doi.org/10.3746/jkfn.2008.37.7.879
  31. The Korean Nutrition Society [Internet]. Dietary Reference Intakes for Koreans [cited 2009 January 5]. Available from: http://www. kns.or.kr/.
  32. Zimmermann C, Winnefeld K, Streck S, Roskos M, Haberl RL. Antioxidant status in acute stroke patients and patients at stroke risk. Eur Neurol 2004;51:157-61. https://doi.org/10.1159/000077662
  33. Choi-Kwon S, Kim HS, Kwon SU, Kim JS. Factors affecting the burden on caregivers of stroke survivors in South Korea. Arch Phys Med Rehabil 2005;86:1043-8. https://doi.org/10.1016/j.apmr.2004.09.013
  34. Youn G, Knight BG, Jeong HS, Benton D. Differences in familism values and caregiving outcomes among Korean, Korean American, and White American dementia caregivers. Psychol Aging 1999;14:355-64.
  35. Mazaki T, Ebisawa K. Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature. J Gastrointest Surg 2008;12:739-55. https://doi.org/10.1007/s11605-007-0362-1
  36. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. Am J Med 1977;62:707-14. https://doi.org/10.1016/0002-9343(77)90874-9
  37. Makola D, Krenitsky J, Parrish C, Dunston E, Shaffer HA, Yeaton P, Kahaleh M. Efficacy of enteral nutrition for the treatment of pancreatitis using standard enteral formula. Am J Gastroenterol 2006;101:2347-55. https://doi.org/10.1111/j.1572-0241.2006.00779.x
  38. Sirdah MM, El-Agouza IM, Abu Shahla AN. Possible ameliorative effect of taurine in the treatment of iron-deficiency anaemia in female university students of Gaza, Palestine. Eur J Haematol 2002;69:236-42. https://doi.org/10.1034/j.1600-0609.2002.02722.x

Cited by

  1. Malnutrition in Patients with Acute Stroke vol.2011, pp.2090-0732, 2011, https://doi.org/10.1155/2011/167898
  2. Comparison of nutritional status indicators according to feeding methods in patients with acute stroke vol.17, pp.3, 2014, https://doi.org/10.1179/1476830513Y.0000000078
  3. Modified B-ultrasound method for measurement of antral section only to assess gastric function and guide enteral nutrition in critically ill patients vol.23, pp.28, 2017, https://doi.org/10.3748/wjg.v23.i28.5229
  4. Effect of Early Enteral Nutrition Support on Nitrogen Balance and Nihss Score in Elderly Patients With Acute Cerebral Stroke and Dysphagia vol.29, pp.1, 2018, https://doi.org/10.1515/pteridines-2018-0010